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Breast Cancer Survivors · Journal article
Asia-pacific Journal of Oncology Nursing · March 2, 2026
Early or partial results. Treat as a signal, not a conclusion.
This systematic review and meta-analysis of 11 RCTs (950 participants) found that exercise interventions significantly improved VO2peak and left ventricular ejection fraction in breast cancer survivors treated with cardiotoxic therapy, though with substantial heterogeneity. The certainty of evidence was rated very low by GRADE, and effectiveness on secondary outcomes remains uncertain, requiring further rigorously designed trials.
Systematic review and meta-analysis of randomised controlled trials. Breast cancer survivors who received cancer therapy associated with cardiotoxicity. Intervention: Self-management interventions, primarily aerobic and/or resistance exercise programmes. Compared with: Control or usual care. n = 950.
Exercise interventions significantly improved VO2peak (MD = 2.71, 95% CI 1.23 to 4.20, P < 0.001) Left ventricular ejection fraction improved (MD = 1.80, 95% CI 0.06 to 3.54, P = 0.043) 516 participants (54%) were allocated to self-management intervention groups, while 434 (46%) were assigned to control/usual care
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Exercise-based self-management may attenuate cancer therapy-induced cardiotoxicity in breast cancer survivors, with VO2peak emerging as a more sensitive marker than LVEF. However, the very-low certainty of evidence and substantial heterogeneity limit confidence in the magnitude and consistency of benefit, warranting caution in clinical application pending higher-quality trials.
Meta-analysis of 11 small RCTs shows promising signals for exercise on cardiotoxicity markers but very-low-certainty evidence by GRADE and substantial heterogeneity.
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Exercise-based self-management may attenuate cancer therapy-induced cardiotoxicity in breast cancer survivors, with VO2peak emerging as a more sensitive marker than LVEF. However, the very-low certainty of evidence and substantial heterogeneity limit confidence in the magnitude and consistency of benefit, warranting caution in clinical application pending higher-quality trials.
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Objective. To evaluate the effectiveness of self-management interventions in reducing cancer therapy-induced cardiotoxicity among breast cancer survivors.Methods. Six English-language databases were searched for studies from January 2004 to November 2024. JBI appraisal tools and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework were applied to assess the methodological quality and certainty of the evidence. Meta-analysis and descriptive qualitative synthesis were applied.Results. A total of 11 randomised controlled trials (RCTs) involving 950 participants were included. A total of 516 participants (54%) were allocated to self-management intervention (e.g., aerobic and/or resistance exercise) groups, while 434 participants (46%) were assigned to control/usual care groups. The most frequently assessed cardiotoxicity-related parameters were cardiorespiratory fitness, cardiac function, and biomarkers, all of which may be attenuated by exercise. The meta-analysis indicated that exercise interventions significantly improved VO2peak (MD = 2.71, 95% CI 1.23 to 4.20, P < 0.001) and left ventricular ejection fraction (MD = 1.80, 95% CI 0.06 to 3.54, P = 0.043), although heterogeneity was substantial. However, the effectiveness of exercise on secondary outcomes remains uncertain, the GRADE framework rated the certainty of the evidence as very low.Conclusions. Exercise has emerged as the most frequently employed self-management strategy for mitigating therapy-induced cardiotoxicity among breast cancer survivors. Evidence has indicated that structured exercise may help attenuate cancer therapy-induced cardiotoxicity, with VO2peak emerging as a more sensitive marker than left ventricular ejection fraction. Nonetheless, further rigorously designed RCTs are warranted to solidify the evidence base and evaluate exercise interventions' long-term sustainability and broader health benefits.Systematic review registration. PROSPERO: CRD42024621854.
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